tbuckley/cabot-search huggingface dataset:
Abstract 39: Association of Cardiovascular Health With Time Lived Free of Coronary Artery Calcium
Authors: Nilay S Shah, Xiaoning Huang, Natalie Cameron, Lucia Petito, Norrina B Allen, Mercedes R Carnethon, Philip Greenland, Donald Lloyd-Jones, Sadiya S Khan
Journal: Circulation (2023)

Introduction: Zero coronary artery calcium (CAC) is associated with lower risk of cardiovascular disease. More time lived without CAC may delay coronary artery disease morbidity, but prediction of when CAC will first develop is not well understood. To inform cardiovascular prevention, we evaluated how cardiovascular health (CVH) relates to time lived without CAC. Methods: In Multi-Ethnic Study of Atherosclerosis (MESA) participants with zero CAC at baseline followed up to 10 years, we used Kaplan-Meier curves to estimate restricted mean survival time since study entry lived with zero CAC, by baseline CVH per Life’s Simple 7 metrics categorized as high (score 12-14), moderate (8-11), and low (0-7), and stratified by sex and age (45-64, 65-84 years). Results: Among 3416 participants without CAC at baseline (63% female, mean age 58 [SD 9] years, mean CVH score 8.8 [2.1]), mean years lived with zero CAC was 4.9 (SD 3.5) years. Women with high CVH lived on average 6.6 (95% CI 6.4-6.8) years with zero CAC, with moderate CVH 6.2 (6.1-6.3) years with zero CAC, and with low CVH 5.6 (5.3-5.8) years with zero CAC. Men with high CVH lived on average 6.4 (5.9-6.9) years with zero CAC, with moderate CVH 6.1 (5.9-6.3) years with zero CAC, and with low CVH 5.5 (5.1-5.9) years with zero CAC (Figure A). Among participants aged 45-64 years, those with high CVH lived on average 7.4 (7.1-7.6) years with zero CAC, with moderate CVH 6.8 (6.6-6.9) years with zero CAC, and with low CVH 5.9 (5.7-6.2) years with zero CAC. Among participants aged 65-84 years, those with high CVH lived on average 5.1 (4.5-5.7) years with zero CAC, with moderate CVH 5.2 (5.0-5.4) years with zero CAC, and with low CVH 4.9 (4.6-5.2) years with zero CAC (Figure B). Conclusions: High CVH was associated with longer time lived with zero CAC in women and men. Adults aged 45-64 years with high or intermediate CVH at baseline had longer time lived with zero CAC compared with those with low CVH. Older adults had no difference in time lived with zero CAC based on CVH. Maintaining CVH in midlife may delay onset of CAC.
Abstract P148: Perceived Religious Influence on Health is Associated With Beneficial Cardiovascular Health Behaviors Within Predominantly Black Churches in New Orleans, Louisiana
Authors: Farah Allouch, Katherine T Mills, Jodie Laurent, Flor Alvarado, Jeanette Gustat, Hua He, Jiang He
Journal: Circulation (2023)

Introduction: CVD is the leading cause of death in the US. Black populations are disproportionately affected by CVD. Further, Black populations have substantially high rates of religiosity. Previous research has demonstrated a positive correlation between religiosity and health, but the mechanisms are unclear. In this study, we describe the relationship between perceived religious influence on CVD health behaviors, risk factors and confidence in participating in medical care within predominantly Black churches in New Orleans, Louisiana. Hypothesis: Perceived religious influence on health is positively associated with CVD health behaviors, risk factors and confidence in participating in medical care. Methods: A survey in 302 members of 13 churches with predominantly Black congregations was conducted during the needs assessment of the Church-based Health Intervention to Eliminate Racial Inequalities in Cardiovascular Health (CHERISH) trial. Religious influence on health was assessed with two statements, (1) “Religious beliefs have great influence on my health” and (2) “I tend to avoid things harmful to my body because of religious beliefs” and measured with a five-point Likert scale ranging from “strongly disagree” to “strongly agree”. Outcomes included fruit and vegetable intake, physical activity, smoking status, self-reported hypertension, hypercholesterolemia, diabetes, and confidence in asking questions to provider and understanding treatment plans. Logistic regression and cumulative odds logistic regression models were used to examine the association with individual and composite outcomes, respectively, adjusting for age, sex, and education. Results: Survey respondents were 77% (233/302) female with a mean age of 65.5 years, and 72% (218/302), 56% (168/302), and 37% (111/302) reported hypertension, hypercholesterolemia, and diabetes, respectively. Perceived religious influence on health was associated with daily fruit and vegetable consumption (OR = 1.64; 95% CI: 1.01, 2.67), physical activity (OR = 1.76; 95% CI: 1.05, 2.96), composite health behaviors (OR = 1.59; 95% CI: 1.03, 2.48), confidence in asking questions to provider (OR = 3.46; 95% CI: 1.41, 9.12), and the composite confidence outcome (OR = 2.11; 95% CI: 1.06, 4.26). Avoiding harmful things because of religion was associated with physical activity (OR = 1.97; 95% CI: 1.17, 3.38) and composite health behaviors (OR = 1.56; 95% CI: 1.01, 2.42). There was no association between the exposures and self-reported hypertension, hypercholesterolemia, or diabetes. Conclusion: Perceived religious influence on health was associated with beneficial CVD health behaviors and confidence in participating in medical care. These findings may inform cultural tailoring of interventions to reduce CVD among the US Black population.
Abstract P471: Predictors of Referral to Community-Based Rehabilitation Following Stroke
Authors: Sara B Jones, Anna M Johnson, Elizabeth R Mormer, Kristin E Ressel, Amy M Pastva, Molly Wen, Charity G Patterson, Pamela W Duncan, Cheryl D Bushnell, Janet K Freburger
Journal: Circulation (2023)

Background: While several studies have examined care transitions following stroke, few have assessed use of rehabilitation. We explored factors predictive of referral to community-based rehabilitation following stroke. Setting: 40 NC acute care hospitals that participated in the COMprehensive Post-Acute Stroke Services study from 2016-2019. Participants: Adults discharged home following stroke or TIA (N=11,195) Methods: Guided by an a priori conceptual framework, 41 predictors of referral to community-based rehabilitation were grouped into 3 patient-level domains: demographics, stroke severity, and medical history (e.g., prior stroke); 2 hospital-level domains: structural characteristics (e.g., bed size) and stroke-specific characteristics (e.g., stroke center status); and 1 community-level domain (county-level therapist supply). We estimated predictors of referral using a logistic mixed model with a hospital-specific random effect. We used a hierarchical backward selection approach, first performing domain-specific model selection, then entering retained variables into a complete model. Results: The cohort was 49% female, 72% white, with a mean age of 66.8 (SD=14.0) years and overall low stroke severity [mean [SD] NIHSS 2.4 [3.8]). Thirty-six percent of patients were referred to rehabilitation. Referral varied across hospitals, ranging from 3-78%, with a median of 35%. In the final model, older age, female sex, non-white race, higher stroke severity, longer length of stay, previous stroke, current smoking, and heart failure were associated with higher odds of referral as was hospital-employed vs. external-contracted OT services (Table). Discussion: Approximately one-third of stroke survivors discharged home were referred to community-based rehabilitation. Women and non-white patients had higher odds of referral. Hospital and community factors were largely not independent predictors of referral. Unmeasured process measures may play a role in unexplained hospital variation.
Abstract P344: Trends and Disparities in Lifestyle Quality Among US Adults With Diabetes
Authors: Chengwu Feng, Li Feng, Zhilei Shan, Han Han, Yaying Cao, Aili Sheng, Marta Guasch, Liang Wang, Geng Zong
Journal: Circulation (2023)

Introduction: Lifestyle modification is the cornerstone of diabetes management, yet, little is known about trends in overall lifestyle quality among people with diabetes (PWD). Hypothesis: We hypothesized that the lifestyle quality of PWD would be improved and the disparities would be narrowed given the great efforts made in the past two decades. Methods: We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey to assess national trends in lifestyle quality among PWD from 1999 through 2018. Accordingly, a well-established healthy lifestyle score involving four low-risk factors: never smoking, moderate alcohol consumption (women ≤ 1 drink/day, men ≤ 2 drinks/day), regular physical activity (top third of physical activity), and healthy diet (top two-fifths of healthy eating index 2015) was constructed with the range from 0 to 4. Results: Among 7410 participants included (weighted mean age, 59.8 years; 51.0% men), the estimated mean healthy lifestyle score slightly increased from 1.4 (95% CI: 1.3 to 1.5) in 1999-2002 to 1.6 (1.5 to 1.8) in 2015-2018 (P for trend=0.002). Only 22.0% of PWD reported adhering to 3-4 low-risk lifestyle factors in 2015-2018. During this period, the non-Hispanic Blacks caught up with the non-Hispanic White in overall lifestyle quality (1.7 vs 1.6 in 2015-2018), but large disparities remained by poverty-income ratio, education level, and health insurance status. By 2015-2018, the estimated mean lifestyle score was lower among participants with lower (1.2, 95% CI: 1.0 to 1.3) vs higher income (1.7, 1.6 to 1.8), lower (1.4, 1.3 to 1.5) vs higher education (1.8, 1.7 to 2.0), and among uninsured (1.4, 1.2 to 1.6) vs insured adults (1.7, 1.5 to 1.8). Conclusions: The overall lifestyle quality of US adults with diabetes was far below optimal levels and large socioeconomic disparities remained. The potential for lifestyle improvement remains large and may further facilitate long-term survival among PWD whose metabolic control has plateaued and whose causes of death diversify.
Abstract P174: The Association Between Infection-Related Hospitalization and Incident Heart Failure: The Atherosclerosis Risk in Communities Study
Authors: Rebecca L Molinsky, Amil M Shah, Melana Yuzefpolskaya, Bing Yu, Jeffrey Misialek, Bruno Bohn, David Vock, Richard Maclehose, Paolo C Colombo, Chiadi E Ndumele, Junichi Ishigami, Kuni Matsushita, Pamela L Lutsey, Ryan Demmer
Journal: Circulation (2023)

Introduction: Infections are associated with worse clinical outcomes among patients with heart failure (HF). However, little is known about the influence of infection-related hospitalizations on development of incident HF and its subtype. Hypothesis: We hypothesize that those with an infection-related hospitalization (hereafter ‘infection’) compared to those without infection, will experience an increased rate of incident HF events (any HF, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF)). Methods: We examined 14,398 participants enrolled in the Atherosclerosis Risk in Communities Study who were HF free at visit 1 (1987-1989). Hospitalized infections and HF were identified via participant self-report and active surveillance of hospitalizations. Among the hospitalized, infection was further defined using ICD-9/10 codes in the first five positions of hospital records. A subset of HF events was further classified as HFpEF or HFrEF via chart abstraction and adjudication by centrally trained and certified physicians. Infection was treated as a time-varying exposure and the co-occurrence of infection and HF in the same hospital visit were excluded. Multivariable-adjusted Cox proportional hazards models assessed the association between infection and incident HF, HFrEF, and HFpEF. Results: The overall baseline sample was 54% (7,835 of 14,398) female, 26% (3,688 of 14,398) Black and had a mean(SD) age of 54(5.8). Mean(SD) time to infection was 16.1(8.7) years, and 2.3(7.5) years from infection to incident HF. Average follow-up among the full sample was 23.0(8.5). Overall, 46% (6,603 of 14,398) had an infection and 3,561 developed any HF. Among participants with subtype adjudication, 470 had HFpEF and 450 had HFrEF. Infection-related hospitalization was associated with an increased risk for both HFpEF and HFrEF (Table). Conclusion: Infection-related hospitalization was associated with both incident HFpEF and HFrEF. A stronger effect is seen among those with HFpEF.
Abstract P594: High-Density Lipoprotein Particle Concentrations and Long-Term Atherosclerotic Disease Risk in Young Adults
Authors: John T Wilkins, Waleed Alruwaili, Hongyan Ning, Konrad T Sawicki, Allan D Sniderman, James D Otvos, David R Jacobs, Venkatesh L Murthy, Ravi V Shah, Anand Rohatgi, Norrina B Allen
Journal: Circulation (2023)

Introduction: HDL particles vary in size and concentration. Indices of overall HDL particle concentration (HDL-P) and the concentrations of different HDL size subspecies (small: H1-H3, medium: H4, H5, and large: H6, H7) have differential associations with near-term CVD events in middle-aged adults. It is unclear if measures of HDL particle concentration predict long-term ASCVD risk in young adults. Methods: Among CARDIA participants (ppts), NMR was used to measure HDL-P and HDL particle size subgroup H1-H7 concentrations. HDL cholesterol (HDL-C) was measured using standard assays. We stratified the ppts into 2 age windows: 20-30y (n= 1645) and 30-40y (n=2922). We used adjusted Cox proportional hazards models to assess the associations between a 1SD higher HDL-C, HDL-P, and HDL1-7 subgroups with incident ASCVD events. We added HDL-P, HDL H1-H7, and HDL-C separately to a modified Pooled Cohort Equation (PCE) model; model performance (discrimination and reclassification) was evaluated. Results: 81 and 163 ASCVD events occurred over (median (IQR)) 31.8y (31.1-32.0y) for the 20-30y age window and over 26.8y (19.1-27.1y) for the 30-40y age window, respectively. In ppts age 20-30y, a higher HDL-P and HDL-C were not associated with ASCVD events, however a higher HDL H6 subgroup level was associated with lower risk for ASCVD in demographic adjusted models. In the age 30-40y group, higher HDL-P, HDL-C, and H6 subgroup were significantly associated with lower ASCVD risks in all models. There were no significant differences in c-statistics across PCE models. However, there were improvements in reclassification for all HDL measures when added to the PCE model in the 20-30y age window, and significant improvements in reclassification when HDL H1-7 were added to the PCE for the 30-40y age window. Conclusion: At younger ages (&lt;40y) differences in HDL particle abundance, in particular large particles, may help reclassify long-term risk for ASCVD in some.
Abstract P197: HbA1c Partially Mediates the Effect of Tyrosine and Phenylalanine on Incident Myocardial Infarction
Authors: Sarah H Koenigsberg, Mariaelisa Graff, Anna F Ballou, Carolina G Downie, Annie Green Howard, Moa P Lee, Kari E North, Laura M Raffield, Rina Yarosh, Penny Gordon-Larsen, Christy L Avery
Journal: Circulation (2023)

Introduction: The aromatic amino acids tyrosine and phenylalanine may increase type 2 diabetes risk, but few studies have examined whether these critical molecular precursors exert additional phenotypic effects and whether these effects are independent of insulin resistance. We evaluated associations between two aromatic amino acids - tyrosine and phenylalanine - with a broad range of phenotypic categories in the UK Biobank using polygenic risk score (PRS) instrumental variables that are robust to confounding and reverse causation and tested for mediation by glycated hemoglobin (HbA1c) as a measure of insulin resistance. Hypothesis: We hypothesized that tyrosine and phenylalanine would show broad phenotypic effects and that many of these effects would be mediated by HbA1c. Methods: We constructed PRS (Crosspred) using all nominally significant and common (minor allele frequency &gt;5%) variants from genome-wide association studies (SAIGE) of unrelated European ancestry participants in the UK Biobank. We evaluated associations with 273 curated phenotypes spanning 20 categories, including endocrine, circulatory, and cancer related traits. We corrected for multiple comparisons using false discovery rate &lt;0.05. Mediation by HbA1c was estimated using the CMAverse package in R, controlling for age, sex, center, ancestral principal components, body mass index, and socioeconomic status. Results: A total of 108,554 participants had tyrosine or phenylalanine measured at baseline (mean age=57 years; 54% (58,880/108,554) female). PRS were predictive of tyrosine (R 2 =0.28) and phenylalanine (R 2 =0.26). Tyrosine and phenylalanine PRS showed significant associations with 121/273 (44%) and 124/273 (45%) of phenotypes, respectively, including chronic kidney disease, serum testosterone, lymphocyte count, and myocardial infarction (MI; n=3,349 cases, mean years of follow-up=11). For incident MI, every one standard deviation increase in the tyrosine PRS increased the odds of MI by 4.4% (total effect odds ratio (OR) = 1.044 (95% confidence interval (CI): 1.002, 1.089). The direct effect of the tyrosine PRS on incident MI was slightly decreased (OR= 1.040 (95% CI: 0.997, 1.084) when extending the statistical model to examine mediation by HbA1c, with an estimated indirect effect of 1.004 (95% CI: 1.003, 1.006) and an estimated percent mediated by HbA1c of 9.95% (95% CI: -0.04%, 19.90%). Findings were consistent for phenylalanine, where the percent of the total effect mediated by HbA1c was 8.94% (95% CI: -1.93, 19.80%). Conclusions: The effect of tyrosine and phenylalanine on incident MI may primarily operate through pathways other than glucose dysregulation.
Abstract MP34: Non-Alcoholic Fatty Liver Disease Modifies the Associations of Body Mass Index and Waist Circumference With Changes in Cardiometabolic Risk: The Cardia Study
Authors: Mahesh Mathew, Mark A Pereira, Zachary C Pope, Pamela J Schreiner, David R Jacobs, James G Terry, Lisa B VanWagner
Journal: Circulation (2023)

Introduction: Non-alcoholic fatty liver disease (NAFLD) is often unrecognized and untreated despite its high prevalence (~25% of adults) and implications for cardiometabolic diseases. We examined the potential for NAFLD to modify the associations between BMI and waist circumference (WC) with changes in cardiometabolic risk. Hypothesis: The associations of BMI and WC with CMR risk are modified by NAFLD. Methods: We analyzed data from Years 25 (2010/11) and 30 (2015/6) of the CARDIA cohort. NAFLD status was determined by noncontrast CT with a liver attenuation cut-off &lt;51 HU after exclusions for other causes of liver fat. The outcome was 5-yr change in cardiometabolic risk score (CMR) derived by the mean Z-score score of fasting glucose, insulin, triglycerides [log], (-)HDL cholesterol, and systolic blood pressure. BMI and WC were directly assessed, and covariates included age, sex, race, center, education, smoking, alcohol, and medications for diabetes or CVD, and Year 25 CMR. Multivariable linear regression models included NAFLD status, BMI, and WC as the independent variables. Effect modification was assessed by interaction terms between NAFLD and continuous BMI and WC in separate models. Subsequent models were stratified by NAFLD status. Results: Our final sample size was 2366 (mean age: 50.1 y, males: 42.6%, Black race: 47.2%) with a NAFLD prevalence of 23% (n=539). Year 25 mean (± sd) CMR for those with and without NAFLD was -0.21 ± 0.58 and 0.50 ± 0.60, respectively. NAFLD status considerably modified the association of both BMI (interaction p&lt;0.001) and WC (interaction p=0.002) with CMR change. BMI and WC were more strongly associated with CMR in participants without NAFLD compared to those with NAFLD (see Table). Within each BMI and WC category, CMR change was higher for those with NAFLD relative to those without NAFLD. Conclusion: NAFLD status modifies the association between BMI and WC with CMR changes. These findings have implications for routine clinical screening guidelines and risk stratification.
Abstract P343: Do Foot Problems in Diabetes Portend Serious Consequences? Calibrating Risk by Comparing Mortality With Cardiovascular Disease Categories
Authors: Issa Zahrieh, Andrew Nicholson, Nicholas Illenberger, Stuart R Lipsitz, Sundar Natarajan
Journal: Circulation (2023)

Patients with diabetic foot disease are predisposed to developing serious cardiovascular and other mortal events. Since it is not clear what the comparative risk for death among adults with diabetes and foot problems is, we conducted a formal analysis comparing these individuals with other established high-risk cardiovascular disease (CVD) categories. We analyzed data from the National Health Interview Survey’s (NHIS) sample adult files between 2001 and 2014. We used information on diabetes and podiatrist care to create a diabetes and foot disease (DFD) variable. Information regarding mortality, cause of death, and follow-up time were from the National Death Index-linked mortality files (maximum 15 years of follow-up). After initially computing mortality rates, we evaluated the independent effect of (DFD) and CVD categories (angina pectoris, coronary heart disease [CHD], heart attacks, heart failure [HF], and stroke) on death using multivariate Cox proportional hazards models that adjusted for age, sex, race, marital status, education, region, physical activity, diet habits, smoking, alcohol consumption, and obesity. Specifically, since our primary interest was in comparing (DFD) with established high-risk cardiovascular disease (CVD) categories, we directly compared (DFD) to the CVD conditions in question through separate Cox models while incorporating (DFD) and the CVD category of interest as 4-level variables and used DFD as referent. Analyses were with SAS 9.4 and incorporated the complex sampling to yield population estimates. Data from 421,106 U.S. adults between 2001 and 2014 were analyzed. There were 8,646 participants with (DFD) and 55,511 with prevalent CVD (angina pectoris 5,989, coronary heart disease 19,832, heart attack 15,065, heart failure 12,344, and stroke 12,434). Over the follow-up period, 1,961 (DFD), 1,173 angina, 4,734 CHD, 3,836 heart attack, 3,526 HF and 3,234 stroke participants died. The mortality rate (per 1000 person-years) was: (DFD) 62, angina 41, CHD 42, heart attack 68, HF 66 and stroke 72. When (DFD) was directly compared to CVD categories, the hazard ratio for death was 1.04 (95% CI 0.93, 1.22) for angina pectoris, 1.05 (95% CI 0.97, 1.14) for CHD, 1.14 (95% CI 1.03, 1.21) for heart attack, 1.15 (95% CI 0.87, 1.34) for HF, and 1.12 (95% CI 1.03, 1.22) for stroke. Individuals with diabetes and foot problems were at equivalent risk for mortality compared to angina or CHD, and at slightly lower mortality risk than heart attack, heart failure or stroke. This population-based analysis quantifies and calibrates the magnitude of the mortality-risk in patients with diabetes and foot disease by comparing it to CVD categories. Current recommendations for care and the structure of care may need to be further refined to match intensity of treatment to mortality risk.